Background: Modern treatment guidelines for women with advanced cervical cancer recommend staging using 2-deoxy-2-[18F]fluoro-D-glucose positron emission computed tomography ([18F]FDG-PET/CT). However, the risk of false-positive nodes and therapy-related adverse events requires caution in treatment planning. Using data from the Netherlands Cancer Registry (NCR), we estimated the impact of [18F]FDG-PET/CT on treatment management in women with locally advanced cervical cancer, i.e., on nodal boosting, field extension, and/or debulking in cases of suspected lymph nodes. Methods: Women diagnosed between 2009 and 2017, who received chemoradiotherapy for International Federation of Gynaecology and Obstetrics (2009) stage IB2, IIA2-IVB cervical cancer with an [18F]FDG-positive node, were retrospectively selected from the NCR database. Patients with pathological nodal examination before treatment were excluded. The frequency of nodal boosting, extended-field radiotherapy, and debulking procedures applied to patients with [18F]FDG-positive lymph nodes was evaluated. Results: Among the 434 eligible patients with [18F]FDG-positive nodes, 380 (88%) received interventions targeting these lymph nodes: 84% of these 380 patients received nodal boosting, 78% extended-field radiotherapy, and 12% debulking surgery. [18F]FDG-positive nodes in patients receiving these treatments were more likely to be classified as suspicious than inconclusive (p= 0.009), located in the para-aortic region (p< 0.001), and larger (p< 0.001) than in patients who did not receive these treatments. Conclusion: While existing guidelines advocate [18F]FDG-PET/CT-guided treatment planning for the management of advanced cervical cancer, this study highlights that not all cases of [18F]FDG-positive nodes received an intervention, possibly due to the risk of false-positive results. Improvement of nodal staging may reduce suboptimal treatment planning.
背景：晚期宫颈癌的现代治疗指南推荐使用2-脱氧-2-[18F]氟代-D-葡萄糖正电子发射计算机断层扫描（[18F]FDG-PET/CT）进行分期。然而，假阳性淋巴结风险及治疗相关不良事件要求治疗计划需谨慎制定。基于荷兰癌症登记处（NCR）的数据，我们评估了[18F]FDG-PET/CT对局部晚期宫颈癌患者治疗管理的影响，具体针对疑似淋巴结病例的淋巴结增量放疗、照射野扩展和/或减瘤手术的应用情况。 方法：从NCR数据库中回顾性筛选2009年至2017年间确诊、接受放化疗治疗的国际妇产科联盟（2009版）分期IB2、IIA2-IVB期宫颈癌且存在[18F]FDG阳性淋巴结的患者。排除治疗前接受过病理淋巴结检查的病例。评估针对[18F]FDG阳性淋巴结患者实施淋巴结增量放疗、扩大野放疗及减瘤手术的频率。 结果：在434例符合条件且存在[18F]FDG阳性淋巴结的患者中，380例（88%）接受了针对这些淋巴结的干预措施：其中84%接受淋巴结增量放疗，78%接受扩大野放疗，12%接受减瘤手术。与未接受干预的患者相比，接受干预患者的[18F]FDG阳性淋巴结更可能被判定为可疑而非不确定（p=0.009），更多位于腹主动脉旁区域（p<0.001），且体积更大（p<0.001）。 结论：尽管现行指南提倡采用[18F]FDG-PET/CT指导晚期宫颈癌的治疗规划，但本研究指出并非所有[18F]FDG阳性淋巴结病例均接受干预措施，这可能与假阳性结果风险有关。改进淋巴结分期方法或可减少次优治疗计划的发生。
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